MHK CareProminenceTM

Integrated medical and pharmacy management

The only platform that combines pharmacy and medical care, MHK CareProminence was purposely built to improve member care by closing care gaps while ensuring continual compliance with changing government regulations.

Compliance Health Care Specialist

Compliance Health Care Specialist

Role Overview

MedHOK (MHK) is a Software as a Service (SaaS) platform used by health plans to perform operational functions, including processing grievances, appeals, pharmacy authorizations and appeals, as well as utilization and care management in compliance with Medicare, Medicaid, NCQA and other state and federal regulations, as applicable.

We are searching for a diligent and professional Compliance Healthcare Specialist to join our dynamic compliance department. You will be responsible for ensuring our business operations and procedures comply with legal regulations and internal policies.

This position will perform a range of duties including, but not limited to, evaluating all current and new compliance regulations, reviewing company policies and procedures, provide subject matter expertise and performing internal audits. The successful candidate will be able to multi-task and be an excellent communicator, with in-depth knowledge of the latest industry trends and regulations.

Responsibilities:

Keep abreast of regulatory developments within or outside of the company as well as evolving regulatory landscapes and best practices in compliance programs

Ensure the MHK solution is compliant with applicable Utilization Management requirements (i.e. Medicare, Medicaid, NCQA) by notifying internal teams of regulatory changes and working with them to develop requirements for enhancements

Educate and communicate verbally and in writing to leadership, impacted staff and current/new clients on any new or changes to regulations

MHK’s mission is to drive better member care in a changing healthcare environment by bringing every care moment in a person’s health journey together through an integrated platform. Through MHK technology, health plans, pharmacy benefit managers, provider organizations and other risk bearing entities can improve health outcomes, reduce administrative expense, and support growth, while maintaining compliance within a changing regulatory requirements. Click here to learn more about MHK solutions.

MHK, part of the Hearst Health network, is a Medical House of Knowledge, where care and knowledge converge. The only service provider that combines pharmacy and medical, MHK’s mission is to drive better member care in a changing healthcare environment by bringing every care moment in a person’s health journey together through an integrated platform. MHK is committed to helping health plans, PBMs, and provider organizations improve quality of care, enhance operational efficiency, maximize revenue, and meet compliance demands. Three of the top five and six of the top ten health plans are served by MHK and forty percent of all 4-5 Star Medicare health plans utilize MHK solutions.